Method and system for incrementally moving teeth

ABSTRACT

A system for repositioning teeth comprises a plurality of individual appliances. The appliances are configured to be placed successively on the patient&#39;s teeth and to incrementally reposition the teeth from an initial tooth arrangement, through a plurality of intermediate tooth arrangements, and to a final tooth arrangement. The system of appliances is usually configured at the outset of treatment so that the patient may progress through treatment without the need to have the treating professional perform each successive step in the procedure.

CROSS-REFERENCES TO RELATED APPLICATIONS

The present application is a continuation of application Ser. No.09/298,268, filed Apr. 23, 1999, now U.S. Pat. No. 6,217,325 which was adivision of application Ser. No. 08/947,080, filed Oct. 8, 1997, nowU.S. Pat. No. 5,975,893 which claimed the benefit of provisionalApplication No. 60/050,342, filed on Jun. 20, 1997, the full disclosuresof which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention is related generally to the field of orthodontics.More particularly, the present invention is related to a method andsystem for incrementally moving teeth from an initial tooth arrangementto a final tooth arrangement.

Repositioning teeth for aesthetic or other reasons is accomplishedconventionally by wearing what are commonly referred to as “braces.”Braces comprise a variety of appliances such as brackets, archwires,ligatures, and O-rings. Attaching the appliances to a patient's teeth isa tedious and time consuming enterprise requiring many meetings with thetreating orthodontist. Consequently, conventional orthodontic treatmentlimits an orthodontist's patient capacity and makes orthodontictreatment quite expensive.

Before fastening braces to a patient's teeth, at least one appointmentis typically scheduled with the orthodontist, dentist, and/or X-raylaboratory so that X-rays and photographs of the patient's teeth and jawstructure can be taken. Also during this preliminary meeting, orpossibly at a later meeting, an alginate mold of the patient's teeth istypically made. This mold provides a model of the patient's teeth thatthe orthodontist uses in conjunction with the X-rays and photographs toformulate a treatment strategy. The orthodontist then typicallyschedules one or more appointments during which braces will be attachedto the patient's teeth.

At the meeting during which braces are first attached, the teethsurfaces are initially treated with a weak acid. The acid optimizes theadhesion properties of the teeth surfaces for brackets and bands thatare to be bonded to them. The brackets and bands serve as anchors forother appliances to be added later. After the acid step, the bracketsand bands are cemented to the patient's teeth using a suitable bondingmaterial. No force-inducing appliances are added until the cement isset. For this reason, it is common for the orthodontist to schedule alater appointment to ensure that the brackets and bands are well bondedto the teeth.

The primary force-inducing appliance in a conventional set of braces isthe archwire. The archwire is resilient and is attached to the bracketsby way of slots in the brackets. The archwire links the bracketstogether and exerts forces on them to move the teeth over time. Twistedwires or elastomeric O-rings are commonly used to reinforce attachmentof the archwire to the brackets. Attachment of the archwire to thebrackets is known in the art of orthodontia as “ligation” and wires usedin this procedure are called “ligatures.” The elastomeric O-rings arecalled “plastics.”

After the archwire is in place, periodic meetings with the orthodontistare required, during which the patient's braces will be adjusted byinstalling a different archwire having different force-inducingproperties or by replacing or tightening existing ligatures. Typically,these meetings are scheduled every three to six weeks.

As the above illustrates, the use of conventional braces is a tediousand time consuming process and requires many visits to theorthodontist's office. Moreover, from the patient's perspective, the useof braces is unsightly, uncomfortable, presents a risk of infection, andmakes brushing, flossing, and other dental hygiene procedures difficult.

For these reasons, it would be desirable to provide alternative methodsand systems for repositioning teeth. Such methods and systems should beeconomical, and in particular should reduce the amount of time requiredby the orthodontist in planning and overseeing each individual patient.The methods and systems should also be more acceptable to the patient,in particular being less visible, less uncomfortable, less prone toinfection, and more compatible with daily dental hygiene. At least someof these objectives will be met by the methods and systems of thepresent invention described hereinafter.

2. Description of the Background Art

Tooth positioners for finishing orthodontic treatment are described byKesling in the Am. J. Orthod. Oral. Surg. 31:297-304 (1945) and32:285-293 (1946). The use of silicone positioners for the comprehensiveorthodontic realignment of a patient's teeth is described in Warunek etal. (1989) J. Clin. Orthod. 23:694-700. Clear plastic retainers forfinishing and maintaining tooth positions are commercially availablefrom Raintree Essix, Inc., New Orleans, La. 70125, and Tru-TainPlastics, Rochester, Minn. 55902. The manufacture of orthodonticpositioners is described in U.S. Pat. Nos. 5,186,623; 5,059,118;5,055,039; 5,035,613; 4,856,991; 4,798,534; and 4,755,139.

Other publications describing the fabrication and use of dentalpositioners include Kleemann and Janssen (1996) J. Clin. Orthodon.30:673-680; Cureton (1996) J. Clin. Orthodon. 30:390-395; Chiappone(1980) J. Clin. Orthodon. 14:121-133; Shilliday (1971) Am. J.Orthodontics 59:596-599; Wells (1970) Am. J Orthodontics 58:351-366; andCottingham (1969) Am. J. Orthodontics 55:23-31.

Kuroda et al. (1996) Am. J. Orthodontics 110:365-369 describes a methodfor laser scanning a plaster dental cast to produce a digital image ofthe cast. See also U.S. Pat. No. 5,605,459.

U.S. Pat. Nos. 5,533,895; 5,474,448; 5,454,717; 5,447,432; 5,431,562;5,395,238; 5,368,478; and 5,139,419, assigned to Ormco Corporation,describe methods for manipulating digital images of teeth for designingorthodontic appliances.

U.S. Pat. No. 5,011,405 describes a method for digitally imaging a toothand determining optimum bracket positioning for orthodontic treatment.Laser scanning of a molded tooth to produce a three-dimensional model isdescribed in U.S. Pat. No. 5,338,198. U.S. Pat. No. 5,452,219 describesa method for laser scanning a tooth model and milling a tooth mold.Digital computer manipulation of tooth contours is described in U.S.Pat. Nos. 5,607,305 and 5,587,912. Computerized digital imaging of thejaw is described in U.S. Pat. Nos. 5,342,202 and 5,340,309. Otherpatents of interest include U.S. Pat. Nos. 5,549,476; 5,382,164;5,273,429; 4,936,862; 3,860,803; 3,660,900; 5,645,421; 5,055,039;4,798,534; 4,856,991; 5,035,613; 5,059,118; 5,186,623; and 4,755,139.

SUMMARY OF THE INVENTION

The present invention provides improved methods and systems forrepositioning teeth from an initial tooth arrangement to a final tootharrangement. Repositioning is accomplished with a system comprising aseries of appliances configured to receive the teeth in a cavity andincrementally reposition individual teeth in a series of at least threesuccessive steps, usually including at least four successive steps,often including at least ten steps, sometimes including at leasttwenty-five steps, and occasionally including forty or more steps. Mostoften, the methods and systems will reposition teeth in from ten totwenty-five successive steps, although complex cases involving many ofthe patient's teeth may take forty or more steps. The successive use ofa number of such appliances permits each appliance to be configured tomove individual teeth in small increments, typically less than 2 mm,preferably less than 1 mm, and more preferably less than 0.5 mm. Theselimits refer to the maximum linear translation of any point on a toothas a result of using a single appliance. The movements provided bysuccessive appliances, of course, will usually not be the same for anyparticular tooth. Thus, one point on a tooth may be moved by aparticular distance as a result of the use of one appliance andthereafter moved by a different distance and/or in a different directionby a later appliance.

The individual appliances will preferably comprise a polymeric shellhaving the teeth-receiving cavity formed therein, typically by moldingas described below. Each individual appliance will be configured so thatits tooth-receiving cavity has a geometry corresponding to anintermediate or end tooth arrangement intended for that appliance. Thatis, when an appliance is first worn by the patient, certain of the teethwill be misaligned relative to an undeformed geometry of the appliancecavity. The appliance, however, is sufficiently resilient to accommodateor conform to the misaligned teeth, and will apply sufficient resilientforce against such misaligned teeth in order to reposition the teeth tothe intermediate or end arrangement desired for that treatment step.

Systems according to the present invention will include at least a firstappliance having a geometry selected to reposition a patient's teethfrom the initial tooth arrangement to a first intermediate arrangementwhere individual teeth will be incrementally repositioned. The systemwill further comprise at least one intermediate appliance having ageometry selective to progressively reposition teeth from the firstintermediate arrangement to one or more successive intermediatearrangements. The system will still further comprise a final appliancehaving a geometry selected to progressively reposition teeth from thelast intermediate arrangement to the desired final tooth arrangement. Insome cases, it will be desirable to form the final appliance or severalappliances to “over correct” the final tooth position, as discussed inmore detail below.

As will be described in more detail below in connection with the methodsof the present invention, the systems may be planned and all individualappliances fabricated at the outset of treatment, and the appliances maythus be provided to the patient as a single package or system. The orderin which the appliances are to be used will be clearly marked, (e.g. bysequential numbering) so that the patient can place the appliances overhis or her teeth at a frequency prescribed by the orthodontist or othertreating professional. Unlike braces, the patient need not visit thetreating professional every time an adjustment in the treatment is made.While the patients will usually want to visit their treatingprofessionals periodically to assure that treatment is going accordingto the original plan, eliminating the need to visit the treatingprofessional each time an adjustment is to be made allows the treatmentto be carried out in many more, but smaller, successive steps whilestill reducing the time spent by the treating professional with theindividual patient. Moreover, the ability to use polymeric shellappliances which are more comfortable, less visible, and removable bythe patient, greatly improves patient compliance, comfort, andsatisfaction.

According to a method of the present invention, a patient's teeth arerepositioned from an initial tooth arrangement to a final tootharrangement by placing a series of incremental position adjustmentappliances in the patient's mouth. Conveniently, the appliances are notaffixed and the patient may place and replace the appliances at any timeduring the procedure. The first appliance of the series will have ageometry selected to reposition the teeth from the initial tootharrangement to a first intermediate arrangement. After the firstintermediate arrangement is approached or achieved, one or moreadditional (intermediate) appliances will be successively placed on theteeth, where such additional appliances have geometries selected toprogressively reposition teeth from the first intermediate arrangementthrough successive intermediate arrangement(s). The treatment will befinished by placing a final appliance in the patient's mouth, where thefinal appliance has a geometry selected to progressively repositionteeth from the last intermediate arrangement to the final tootharrangement. The final appliance or several appliances in the series mayhave a geometry or geometries selected to over correct the tootharrangement, i.e. have a geometry which would (if fully achieved) moveindividual teeth beyond the tooth arrangement which has been selected asthe “final.” Such over correction may be desirable in order to offsetpotential relapse after the repositioning method has been terminated,i.e. to permit some movement of individual teeth back toward theirpre-corrected positions. Over correction may also be beneficial to speedthe rate of correction, i.e. by having an appliance with a geometry thatis positioned beyond a desired intermediate or final position, theindividual teeth will be shifted toward the position at a greater rate.In such cases, treatment can be terminated before the teeth reach thepositions defined by the final appliance or appliances. The method willusually comprise placing at least two additional appliances, oftencomprising placing at least ten additional appliances, sometimes placingat least twenty-five additional appliances, and occasionally placing atleast forty or more additional appliances. Successive appliances will bereplaced when the teeth either approach (within a preselected tolerance)or have reached the target end arrangement for that stage of treatment,typically being replaced at an interval in the range from 2 days to 20days, usually at an interval in the range from 5 days to 10 days.

Often, it may be desirable to replace the appliances at a time beforethe “end” tooth arrangement of that treatment stage is actuallyachieved. It will be appreciated that as the teeth are graduallyrepositioned and approach the geometry defined by a particularappliance, the repositioning force on the individual teeth will diminishgreatly. Thus, it may be possible to reduce the overall treatment timeby replacing an earlier appliance with the successive appliance at atime when the teeth have been only partially repositioned by the earlierappliance. Thus, the FDDS can actually represent an over correction ofthe final tooth position. This both speeds the treatment and can offsetpatient relapse.

In general, the transition to the next appliance can be based on anumber of factors. Most simply, the appliances can be replaced on apredetermined schedule or at a fixed time interval (i.e. number of daysfor each appliance) determined at the outset based on an expected ortypical patient response. Alternatively, actual patient response can betaken into account, e.g. a patient can advance to the next appliancewhen that patient no longer perceives pressure on their teeth from acurrent appliance, i.e. the appliance they have been wearing fits easilyover the patient's teeth and the patient experiences little or nopressure or discomfort on his or her teeth. In some cases, for patientswhose teeth are responding very quickly, it may be possible for atreating professional to decide to skip one or more intermediateappliances, i.e. reduce the total number of appliances being used belowthe number determined at the outset. In this way, the overall treatmenttime for a particular patient can be reduced.

In another aspect, methods of the present invention compriserepositioning teeth using appliances comprising polymeric shells havingcavities shaped to receive and resiliently reposition teeth to produce afinal tooth arrangement. The present invention provides improvements tosuch methods which comprise determining at the outset of treatmentgeometries for at least three of the appliances which are to be wornsuccessively by a patient to reposition teeth from an initial tootharrangement to the final tooth arrangement. Preferably, at least fourgeometries will be determined in the outset, often at least tengeometries, frequently at least twenty-five geometries, and sometimesforty or more geometries. Usually, the tooth positions defined by thecavities in each successive geometry differ from those defined by theprior geometry by no more than 2 mm, preferably no more than 1 mm, andoften no more than 0.5 mm, as defined above.

In yet another aspect, methods are provided for producing a digital dataset representing a final tooth arrangement. The methods compriseproviding an initial data set representing an initial tooth arrangement,and presenting a visual image based on the initial data set. The visualimage is then manipulated to reposition individual teeth in the visualimage. A final digital data set is then produced which represents thefinal tooth arrangement with repositioned teeth as observed in thevisual image. Conveniently, the initial digital data set may be providedby conventional techniques, including digitizing X-ray images, imagesproduced by computer-aided tomography (CAT scans), images produced bymagnetic resonance imaging (MRI), and the like. Preferably, the imageswill be three-dimensional images and digitization may be accomplishedusing conventional technology. Usually, the initial digital data set isprovided by producing a plaster cast of the patient's teeth (prior totreatment) by conventional techniques. The plaster cast so produced maythen be scanned using laser or other scanning equipment to produce ahigh resolution digital representation of the plaster cast of thepatient's teeth. Use of the plaster cast is preferred since it does notexpose the patient to X-rays or subject the patient to the inconvenienceof an MRI scan.

Once the digital data set is acquired, an image can be presented andmanipulated on a suitable computer system equipped with computer-aideddesign software, as described in greater detail below. The imagemanipulation will usually comprise defining boundaries about at leastsome of the individual teeth, and causing the images of the teeth to bemoved relative to the jaw and other teeth by manipulation of the imagevia the computer. The image manipulation can be done entirelysubjectively, i.e. the user may simply reposition teeth in anaesthetically and/or therapeutically desired manner based on observationof the image alone. Alternatively, the computer system could be providedwith rules and algorithms which assist the user in repositioning theteeth. In some instances, it will be possible to provide rules andalgorithms which reposition the teeth in a fully automatic manner, i.e.without user intervention. Once the individual teeth have beenrepositioned, a final digital data set representing the desired finaltooth arrangement will be generated and stored.

A preferred method for determining the final tooth arrangement is forthe treating professional to define the final tooth positions, e.g. bywriting a prescription. The use of prescriptions for defining thedesired outcomes of orthodontic procedures is well known in the art.When a prescription or other final designation is provided, the imagecan then be manipulated to match the prescription. In some cases, itwould be possible to provide software which could interpret theprescription in order to generate the final image and thus the digitaldata set representing the final tooth arrangement.

In yet another aspect, methods according to the present invention areprovided for producing a plurality of digital data sets representing aseries of discrete tooth arrangements progressing from an initial tootharrangement to a final tooth arrangement. Such methods compriseproviding a digital data set representing an initial tooth arrangement(which may be accomplished according to any of the techniques set forthabove). A digital data set representing a final tooth arrangement isalso provided. Such final digital data set may be determined by themethods described previously. The plurality of successive digital datasets are then produced based on the initial digital data set and thefinal digital data set. Usually, the successive digital data sets areproduced by determining positional differences between selectedindividual teeth in the initial data set and in the final data set andinterpolating said differences. Such interpolation may be performed overas many discrete stages as may be desired, usually at least three, oftenat least four, more often at least ten, sometimes at least twenty-five,and occasionally forty or more. Many times, the interpolation will belinear interpolation for some or all of the positional differences.Alternatively, the interpolation may be non-linear. The positionaldifferences will correspond to tooth movements where the maximum linearmovement of any point on a tooth is 2 mm or less, usually being 1 mm orless, and often being 0.5 mm or less.

Often, the user will specify certain target intermediate tootharrangements, referred to as “key frames,” which are incorporateddirectly into the intermediate digital data sets. The methods of thepresent invention then determine successive digital data sets betweenthe key frames in the manner described above, e.g. by linear ornon-linear interpolation between the key frames. The key frames may bedetermined by a user, e.g. the individual manipulating a visual image atthe computer used for generating the digital data sets, or alternativelymay be provided by the treating professional as a prescription in thesame manner as the prescription for the final tooth arrangement.

In still another aspect, methods according to the present inventionprovide for fabricating a plurality of dental incremental positionadjustment appliances. Said methods comprise providing an initialdigital data set, a final digital data set, and producing a plurality ofsuccessive digital data sets representing the target successive tootharrangements, generally as just described. The dental appliances arethen fabricated based on at least some of the digital data setsrepresenting the successive tooth arrangements. Preferably, thefabricating step comprises controlling a fabrication machine based onthe successive digital data sets to produce successive positive modelsof the desired tooth arrangements. The dental appliances are thenproduced as negatives of the positive models using conventional positivepressure or vacuum fabrication techniques. The fabrication machine maycomprise a stereolithography or other similar machine which relies onselectively hardening a volume of non-hardened polymeric resin byscanning a laser to selectively harden the resin in a shape based on thedigital data set. Other fabrication machines which could be utilized inthe methods of the present invention include tooling machines and waxdeposition machines.

In still another aspect, methods of the present invention forfabricating a dental appliance comprise providing a digital data setrepresenting a modified tooth arrangement for a patient. A fabricationmachine is then used to produce a positive model of the modified tootharrangement based on the digital data set. The dental appliance is thenproduced as a negative of the positive model. The fabrication machinemay be a stereolithography or other machine as described above, and thepositive model is produced by conventional pressure or vacuum moldingtechniques.

In a still further aspect, methods for fabricating a dental applianceaccording to the present invention comprise providing a first digitaldata set representing a modified tooth arrangement for a patient. Asecond digital data set is then produced from the first digital dataset, where the second data set represents a negative model of themodified tooth arrangement. The fabrication machine is then controlledbased on the second digital data set to produce the dental appliance.The fabrication machine will usually rely on selectively hardening anon-hardened resin to produce the appliance. The appliance typicallycomprises a polymeric shell having a cavity shape to receive andresiliently reposition teeth from an initial tooth arrangement to themodified tooth arrangement.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A illustrates a patient's jaw and provides a general indication ofhow teeth may be moved by the methods and apparatus of the presentinvention.

FIG. 1B illustrates a single tooth from FIG. 1A and defines how toothmovement distances are determined.

FIG. 1C illustrates the jaw of FIG. 1A together with an incrementalposition adjustment appliance which has been configured according to themethods of the present invention.

FIG. 2 is a block diagram illustrating the steps of the presentinvention for producing a system of incremental position adjustmentappliances.

FIG. 3 is a block diagram setting forth the steps for manipulating aninitial digital data set representing an initial tooth arrangement toproduce a final digital data set corresponding to a desired final tootharrangement.

FIG. 4 is a flow chart illustrating an eraser tool for the methodsherein.

FIG. 4A illustrates the volume of space which is being erased by theprogram of FIG. 4.

FIG. 5 is a flow chart illustrating a program for matchinghigh-resolution and low-resolution components in the manipulation ofdata sets of FIG. 3.

FIG. 6 illustrates the method for generating multiple intermediatedigital data sets which are used for producing the adjustment appliancesof the present invention.

FIG. 7 illustrates alternative processes for producing a plurality ofappliances according to the methods of the present invention utilizingdigital data sets representing the intermediate and final appliancedesigns.

DESCRIPTION OF THE SPECIFIC EMBODIMENTS

According to the present invention, systems and methods are provided forincrementally moving teeth using a plurality of discrete appliances,where each appliance successively moves one or more of the patient'steeth by relatively small amounts. The tooth movements will be thosenormally associated with orthodontic treatment, including translation inall three orthogonal directions relative to a vertical centerline,rotation of the tooth centerline in the two orthodontic directions(“root angulation” and “torque”), as well as rotation about thecenterline.

Referring now to FIG. 1A, a representative jaw 100 includes sixteenteeth 102. The present invention is intended to move at least some ofthese teeth from an initial tooth arrangement to a final tootharrangement. To understand how the teeth may be moved, an arbitrarycenterline (CL) is drawn through one of the teeth 102. With reference tothis centerline (CL), the teeth may be moved in the orthogonaldirections represented by axes 104, 106, and 108 (where 104 is thecenterline). The centerline may be rotated about the axis 108 (rootangulation) and 104 (torque) as indicated by arrows 110 and 112,respectively. Additionally, the tooth may be rotated about thecenterline, as represented by arrow 114. Thus, all possible free-formmotions of the tooth can be performed. Referring now to FIG. 1B, themagnitude of any tooth movement achieved by the methods and devices ofthe present invention will be defined in terms of the maximum lineartranslation of any point P on a tooth 102. Each point Pi will undergo acumulative translation as that tooth is moved in any of the orthogonalor rotational directions defined in FIG. 1A. That is, while the pointwill usually follow a non-linear path, there will be a linear distancebetween any point in the tooth when determined at any two times duringthe treatment. Thus, an arbitrary point P1 may in fact undergo a trueside-to-side translation as indicated by arrow d1, while a secondarbitrary point P2 may travel along an arcuate path, resulting in afinal translation d2. Many aspects of the present invention are definedin terms of the maximum permissible movement of a point Pi induced bythe methods in any particular tooth. Such maximum tooth movement, inturn, is defined as the maximum linear translation of that point Pi onthe tooth which undergoes the maximum movement for that tooth in anytreatment step.

Referring now to FIG. 1C, systems according to the present inventionwill comprise a plurality of incremental position adjustment appliances.The appliances are intended to effect incremental repositioning ofindividual teeth in the jaw as described generally above. In a broadestsense, the methods of the present invention can employ any of the knownpositioners, retainers, or other removable appliances which are knownfor finishing and maintaining teeth positions in connection withconventional orthodontic treatment. The systems of the presentinvention, in contrast with prior apparatus and systems, will provide aplurality of such appliances intended to be worn by a patientsuccessively in order to achieve the gradual tooth repositioning asdescribed herein. A preferred appliance 100 will comprise a polymericshell having a cavity shaped to receive and resiliently reposition teethfrom one tooth arrangement to a successive tooth arrangement. Thepolymeric shell will preferably, but not necessarily, fit over all teethpresent in the upper or lower jaw. Often, only certain one(s) of theteeth will be repositioned while others of the teeth will provide a baseor anchor region for holding the repositioning appliance in place as itapplies the resilient repositioning force against the tooth or teeth tobe repositioned. In complex cases, however, many or most of the teethwill be repositioned at some point during the treatment. In such cases,the teeth which are moved can also serve as a base or anchor region forholding the repositioning appliance. Additionally, the gums and/or thepalette can serve as an anchor region, thus allowing all or nearly allof the teeth to be repositioned simultaneously.

The polymeric appliance 100 of FIG. 1C is preferably formed from a thinsheet of a suitable elastomeric polymeric, such as Tru-Tain 0.03 in.thermal forming dental material, Tru-Tain Plastics, Rochester, Minn.55902. Usually, no wires or other means will be provided for holding theappliance in place over the teeth. In some cases, however, it will bedesirable or necessary to provide individual anchors on teeth withcorresponding receptacles or apertures in the appliance 100 so that theappliance can apply an upward force on the tooth which would not bepossible in the absence of such an anchor. Specific methods forproducing the appliances 100 are described hereinafter.

Referring now to FIG. 2, the overall method of the present invention forproducing the incremental position adjustment appliances for subsequentuse by a patient to reposition the patient's teeth will be described. Asa first step, a digital data set representing an initial tootharrangement is obtained, referred to hereinafter as the IDDS. The IDDSmay be obtained in a variety of ways. For example, the patient's teethmay be scanned or imaged using well known technology, such as X-rays,three-dimensional X-rays, computer-aided tomographic images or datasets, magnetic resonance images, etc. Methods for digitizing suchconventional images to produce data sets useful in the present inventionare well known and described in the patent and medical literature.Usually, however, the present invention will rely on first obtaining aplaster cast of the patient's teeth by well known techniques, such asthose described in Graber, Orthodontics: Principle and Practice, SecondEdition, Saunders, Philadelphia, 1969, pp. 401-415. After the toothcasting is obtained, it can be digitally scanned using a conventionallaser scanner or other range acquisition system to produce the IDDS. Thedata set produced by the range acquisition system may, of course, beconverted to other formats to be compatible with the software which isused for manipulating images within the data set, as described in moredetail below. General techniques for producing plaster casts of teethand generating digital models using laser scanning techniques aredescribed, for example, in U.S. Pat. No. 5,605,459, the full disclosureof which is incorporated herein by reference.

There are a variety of range acquisition systems, generally categorizedby whether the process of acquisition requires contact with the threedimensional object. A contact-type range acquisition system utilizes aprobe, having multiple degrees of translational and/or rotationalfreedom. By recording the physical displacement of the probe as it isdrawn across the sample surface, a computer-readable representation ofthe sample object is made. A non-contact-type range acquisition devicecan be either a reflective-type or transmissive-type system. There are avariety of reflective systems in use. Some of these reflective systemsutilize non-optical incident energy sources such as microwave radar orsonar. Others utilize optical energy. Those non-contact-type systemsworking by reflected optical energy further contain specialinstrumentation configured to permit certain measuring techniques to beperformed (e.g., imaging radar, triangulation and interferometry).

A preferred range acquisition system is an optical, reflective,non-contact-type scanner. Non-contact-type scanners are preferredbecause they are inherently nondestructive (i.e., do not damage thesample object), are generally characterized by a higher captureresolution and scan a sample in a relatively short period of time. Onesuch scanner is the Cyberware Model 15 manufactured by Cyberware, Inc.,Monterey, Calif.

Either non-contact-type or contact-type scanners may also include acolor camera, that when synchronized with the scanning capabilities,provides a means for capturing, in digital format, a colorrepresentation of the sample object. The importance of this furtherability to capture not just the shape of the sample object but also itscolor is discussed below.

The methods of the present invention will rely on manipulating the IDDSat a computer or workstation having a suitable graphical user interface(GUI) and software appropriate for viewing and modifying the images.Specific aspects of the software will be described in detailhereinafter. While the methods will rely on computer manipulation ofdigital data, the systems of the present invention comprising multipledental appliances having incrementally differing geometries may beproduced by non-computer-aided techniques. For example, plaster castsobtained as described above may be cut using knives, saws, or othercutting tools in order to permit repositioning of individual teethwithin the casting. The disconnected teeth may then be held in place bysoft wax or other malleable material, and a plurality of intermediatetooth arrangements can then be prepared using such a modified plastercasting of the patient's teeth. The different arrangements can be usedto prepare sets of multiple appliances, generally as described below,using pressure and vacuum molding techniques. While such manual creationof the appliance systems of the present invention will generally be muchless preferred, systems so produced will come within the scope of thepresent invention.

Referring again to FIG. 2, after the IDDS has been obtained, the digitalinformation will be introduced to the computer or other workstation formanipulation. In the preferred approach, individual teeth and othercomponents will be “cut” to permit their individual repositioning orremoval from the digital data. After thus “freeing” the components, theuser will often follow a prescription or other written specificationprovided by the treating professional. Alternatively, the user mayreposition them based on the visual appearance or using rules andalgorithms programmed into the computer. Once the user is satisfied withthe final arrangement, the final tooth arrangement is incorporated intoa final digital data set (FDDS).

Based on both the IDDS and the FDDS, a plurality of intermediate digitaldata sets (INTDDS's) are generated to correspond to successiveintermediate tooth arrangements. The system of incremental positionadjustment appliances can then be fabricated based on the INTDDS's, asdescribed in more detail below.

FIG. 3 illustrates a representative technique for manipulating the IDDSto produce the FDDS on the computer. Usually, the data from the digitalscanner will be in a high resolution form. In order to reduce thecomputer time necessary to generate images, a parallel set of digitaldata set representing the IDDS at a lower resolution will be created.The user will manipulate the lower resolution images while the computerwill update the high resolution data set as necessary. The user can alsoview/manipulate the high resolution model if the extra detail providedin that model is useful. The IDDS will also be converted into a quadedge data structure if not already present in that form. A quad edgedata structure is a standard topological data structure defined inPrimitives for the Manipulation of General Subdivisions and theComputation of Voronoi Diagrams, ACM Transactions of Graphics, Vol. 4,No. 2, April 1985, pp. 74-123. Other topological data structures, suchas the winged-edge data structure, could also be used.

As an initial step, while viewing the three-dimensional image of thepatient's jaw, including the teeth, gingivae, and other oral tissue, theuser will usually delete structure which is unnecessary for imagemanipulation and/or final production of an appliance. These unwantedsections of the model may be removed using an eraser tool to perform asolid modeling subtraction. The tool is represented by a graphic box.The volume to be erased (the dimensions, position, and orientation ofthe box) are set by the user employing the GUI. Typically, unwantedsections would include extraneous gum area and the base of theoriginally scanned cast. Another application for this tool is tostimulate the extraction of teeth and the “shaving down” of toothsurfaces. This is necessary when additional space is needed in the jawfor the final positioning of a tooth to be moved. The treatingprofessional may choose to determine which teeth will be shaved and/orwhich teeth will be extracted. Shaving allows the patient to maintaintheir teeth when only a small amount of space is needed. Typically,extraction and shaving, of course, will be utilized in the treatmentplanning only when the actual patient teeth are to be extracted and/orshaved prior to initiating repositioning according to the methods of thepresent invention.

Removing unwanted and/or unnecessary sections of the model increasesdata processing speed and enhances the visual display. Unnecessarysections include those not needed for creation of the toothrepositioning appliance. The removal of these unwanted sections reducesthe complexity and size of the digital data set, thus acceleratingmanipulations of the data set and other operations.

After the user positions and sizes the eraser tool and instructs thesoftware to erase the unwanted section, all triangles within the box setby the user will be removed and the border triangles are modified toleave a smooth, linear border. The software deletes all of the triangleswithin the box and clips all triangles which cross the border of thebox. This requires generating new vertices on the border of the box. Theholes created in the model at the faces of the box are re-triangulatedand closed using the newly created vertices.

The saw tool is used to define the individual teeth (or possibly groupsof teeth) to be moved. The tool separates the scanned image intoindividual graphic components enabling the software to move the tooth orother component images independent of remaining portions of the model.The saw tool defines a path for cutting the graphic image by using twocubic B-spline curves lying in space, possibly constrained to parallelplanes. A set of lines connects the two curves and shows the user thegeneral cutting path. The user may edit the control points on the cubicB-splines, the thickness of the saw cut, and the number of erasers used,as described below.

Thickness: When a cut is used to separate a tooth, the user will usuallywant the cut to be as thin as possible. However, the user may want tomake a thicker cut, for example, when shaving down surrounding teeth, asdescribed above. Graphically, the cut appears as the curve bounded byhalf the thickness of the cut on each side of the curve.

Number of Erasers: A cut is comprised of multiple eraser boxes arrangednext to each other as a piecewise linear approximation of the Saw Tool=scurve path. The user chooses the number of erasers, which determines thesophistication of the curve created—the greater the number of segments,the more accurately the cutting will follow the curve. The number oferasers is shown graphically by the number of parallel lines connectingthe two cubic B-spline curves. Once a saw cut has been completelyspecified the user applies the cut to the model. The cut is performed asa sequence of erasings. A preferred algorithm is set forth in FIG. 4.FIG. 4A shows a single erasing iteration of the cut as described in thealgorithm.

A preview feature may also be provided in the software. The previewfeature visually displays a saw cut as the two surfaces that representopposed sides of the cut. This allows the user to consider the final cutbefore applying it to the model data set.

After the user has completed all desired cutting operations with the sawtool, multiple graphic solids exist. However, at this point, thesoftware has not determined which triangles of the quad edge datastructure belong to which components. The software chooses a randomstarting point in the data structure and traverses the data structureusing adjacency information to find all of the triangles that areattached to each other, identifying an individual component. Thisprocess is repeated starting with the triangle whose component is notyet determined. Once the entire data structure is traversed, allcomponents have been identified.

To the user, all changes made to the high resolution model appear tooccur simultaneously in the low resolution model, and vice versa.However, there is not a one-to-one correlation between the differentresolution models. Therefore, the computer “matches” the high resolutionand low resolution components as best as it can subject to definedlimits. The algorithm is described in FIG. 5.

After the teeth and other components have been placed or removed so thatthe final tooth arrangement has been produced, it is necessary togenerate a treatment plan, as illustrated in FIG. 6. The treatment planwill ultimately produce the series of INTDDS's and FDDS as describedpreviously. To produce these data sets, it is necessary to define or mapthe movement of selected individual teeth from the initial position tothe final position over a series of successive steps. In addition, itmay be necessary to add other features to the data sets in order toproduce desired features in the treatment appliances. For example, itmay be desirable to add wax patches to the image in order to definecavities or recesses for particular purposes. For example, it may bedesirable to maintain a space between the appliance and particularregions of the teeth or jaw in order to reduce soreness of the gums,avoid periodontal problems, allow for a cap, and the like. Additionally,it will often be necessary to provide a receptacle or aperture intendedto accommodate an anchor which is to be placed on a tooth in order topermit the tooth to be manipulated in a manner that requires the anchor,e.g. lifted relative to the jaw.

Some methods for manufacturing the tooth repositioning appliancesrequire that the separate, repositioned teeth and other components beunified into a single continuous structure in order to permitmanufacturing. In these instances, “wax patches” are used to attachotherwise disconnected components of the INTDDS's. These patches areadded to the data set underneath the teeth and above the gum so thatthey do not effect the geometry of the tooth repositioning appliances.The application software provides for a variety of wax patches to beadded to the model, including boxes and spheres with adjustabledimensions. The wax patches that are added are treated by the softwareas additional pieces of geometry, identical to all other geometries.Thus, the wax patches can be repositioned during the treatment path aswell as the teeth and other components.

In the manufacturing process, which relies on generation of positivemodels to produce the repositioning appliance, adding a wax patch to thegraphic model will generate a positive mold that has the same added waxpatch geometry. Because the mold is a positive of the teeth and theappliance is a negative of the teeth, when the appliance is formed overthe mold, the appliance will also form around the wax patch that hasbeen added to the mold. When placed in the patient's mouth, theappliance will thus allow for a space between the inner cavity surfaceof the appliance and the patient's teeth or gums. Additionally, the waxpatch may be used to form a recess or aperture within the appliancewhich engages an anchor placed on the teeth in order to move the toothin directions which could not otherwise be accomplished.

In addition to such wax patches, an individual component, usually atooth, can be scaled to a smaller or larger size which will result in amanufactured appliance having a tighter or looser fit, respectively.

Treatment planning is extremely flexible in defining the movement ofteeth and other components. The user may change the number of treatmentstages, as well as individually control the path and speed ofcomponents.

Number of Treatment Stages: The user can change the number of desiredtreatment stages from the initial to the target states of the teeth. Anycomponent that is not moved is assumed to remain stationary, and thusits final position is assumed to be the same as the initial position(likewise for all intermediate positions, unless one or more key framesare defined for that component).

Key Frames: The user may also specify “key frames” by selecting anintermediate state and making changes to component position(s). Unlessinstructed otherwise, the software automatically linearly interpolatesbetween all user-specified positions (including the initial position,all key frame positions, and the target position). For example, if onlya final position is defined for a particular component, each subsequentstage after the initial stage will simply show the component an equallinear distance and rotation (specified by a quaternion) closer to thefinal position. If the user specifies two key frames for that component,it will “move” linearly from the initial position through differentstages to the position defined by the first key frame. It will thenmove, possibly in a different direction, linearly to the positiondefined by the second key frame. Finally, it will move, possibly in yeta different direction, linearly to the target position.

The user can also specify non-linear interpolation between the keyframes. A spline curve is used to specify the interpolating function ina conventional manner.

These operations may be done independently to each component, so that akey frame for one component will not affect another component, unlessthe other component is also moved by the user in that key frame. Onecomponent may accelerate along a curve between stages 3 and 8, whileanother moves linearly from stage 1 to 5, and then changes directionsuddenly and slows down along a linear path to stage 10. Thisflexibility allows a great deal of freedom in planning a patient'streatment.

Lastly, the software may incorporate and the user may at any point use a“movie” feature to automatically animate the movement from initial totarget states. This is helpful for visualizing overall componentmovement throughout the treatment process.

Above it was described that the preferred user interface for componentidentification is a three dimensional interactive GUI. Athree-dimensional GUI is also preferred for component manipulation. Suchan interface provides the treating professional or user with instant andvisual interaction with the digital model components. It is preferredover interfaces that permit only simple low-level commands for directingthe computer to manipulate a particular segment. In other words, a GUIadapted for manipulation is preferred over an interface that acceptsdirectives, for example, only of the sort: “translate this component by0.1 mm to the right.” Such low-level commands are useful forfine-tuning, but, if they were the sole interface, the processes ofcomponent manipulation would become a tiresome and time-consuminginteraction.

Before or during the manipulation process, one or more tooth componentsmay be augmented with template models of tooth roots. Manipulation of atooth model augmented with a root template is useful, for example, insituations where impacting of teeth below the gumline is a concern.These template models could, for example, comprise a digitizedrepresentation of the patient's teeth x-rays.

The software also allows for adding annotations to the datasets whichcan comprise text and/or the sequence number of the apparatus. Theannotation is added as recessed text (i.e. it is 3-D geometry), so thatit will appear on the printed positive model. If the annotation can beplaced on a part of the mouth that will be covered by a repositioningappliance, but is unimportant for the tooth motion, the annotation mayappear on the delivered repositioning appliance(s).

The above-described component identification and component manipulationsoftware is designed to operate at a sophistication commensurate withthe operator's training level. For example, the component manipulationsoftware can assist a computer operator, lacking orthodontic training,by providing feedback regarding permissible and forbidden manipulationsof the teeth. On the other hand, an orthodontist, having greater skillin intraoral physiology and teeth-moving dynamics, can simply use thecomponent identification and manipulation software as a tool and disableor otherwise ignore the advice.

Once the intermediate and final data sets have been created, theappliances may be fabricated as illustrated in FIG. 7. Preferably,fabrication methods will employ a rapid prototyping device 200 such as astereolithography machine. A particularly suitable rapid prototypingmachine is Model SLA-250/50 available from 3D System, Valencia, Calif.The rapid prototyping machine 200 will selectively harden a liquid orother non-hardened resin into a three-dimensional structure which can beseparated from the remaining non-hardened resin, washed, and used eitherdirectly as the appliance or indirectly as a mold for producing theappliance. The prototyping machine 200 will receive the individualdigital data sets and produce one structure corresponding to each of thedesired appliances. Generally, because the rapid prototyping machine 200may utilize a resin having non-optimum mechanical properties and whichmay not be generally acceptable for patient use, it will be preferred touse the prototyping machine to produce molds which are, in effect,positive tooth models of each successive stage of the treatment. Afterthe positive models are prepared, a conventional pressure or vacuummolding machine may be used to produce the appliances from a moresuitable material, such as 0.03 inch thermal forming dental material,available from

Tru-Tain Plastics, Rochester, Minn. 55902. Suitable pressure moldingequipment is available under the tradename BIOSTAR from Great LakesOrthodontics, Ltd., Tonawanda, N.Y. 14150. The molding machine 250produces each of the appliances directly from the positive tooth modeland the desired material. Suitable vacuum molding machines are availablefrom Raintree Essix, Inc.

After production, the plurality of appliances which comprise the systemof the present invention are preferably supplied to the treatingprofessional all at one time. The appliances will be marked in somemanner, typically by sequential numbering directly on the appliances oron tags, pouches, or other items which are affixed to or which encloseeach appliance, to indicate their order of use. Optionally, writteninstructions may accompany the system which set forth that the patientis to wear the individual appliances in the order marked on theappliances or elsewhere in the packaging. Use of the appliances in sucha manner will reposition the patient's teeth progressively toward thefinal tooth arrangement.

While the above is a complete description of the preferred embodimentsof the invention, various alternatives, modifications, and equivalentsmay be used. Therefore, the above description should not be taken aslimiting the scope of the invention which is defined by the appendedclaims.

What is claimed is:
 1. A method for fabricating a plurality of dentalincremental position adjustment appliances, said method comprising:providing at the outset of treatment a plurality of digital data setsrepresenting a plurality of successive tooth arrangements progressingfrom an initial tooth arrangement to a final tooth arrangement for anindividual patient; and controlling a fabrication machine based onindividual ones of the digital data sets to produce the plurality ofappliances for the individual patient.
 2. A method as in claim 1,wherein providing the digital data comprises providing a plurality ofdigital data sets, wherein each set represents one of the successivetooth arrangements.
 3. A method as in claim 2, wherein controlling thefabrication machine comprises: providing a volume of non-hardenedpolymeric resin; and selectively hardening the resin in a shapecorresponding to each of the appliances.
 4. A method as in claim 3,wherein hardening comprises scanning a laser to selectively harden theresin.
 5. A method as in claim 3, wherein scanning produces an appliancecomprising a thin polymeric shell.
 6. A method as in claim 1, whereincontrolling the fabrication machine comprises: providing a volume ofnon-hardened polymeric resin; and selectively hardening the resin in ashape corresponding to each of the appliances.
 7. A method as in claim6, wherein selectively hardening comprises scanning a laser toselectively harden the resin.
 8. A method as in claim 6, whereinscanning produces an appliance comprising a thin polymeric shell.
 9. Amethod for fabricating a plurality of dental incremental positionadjustment appliances, said method comprising: providing at the outsetof treatment a plurality of digital data sets representing a pluralityof successive tooth arrangements progressing from an initial tootharrangement to a final tooth arrangement; and controlling a fabricationmachine based on individual ones of the digital data sets to produce theplurality of appliances.
 10. A method as in claim 9, wherein providingthe digital data comprises providing a plurality of digital data sets,wherein each set represents one of the successive tooth arrangements.11. A method as in claim 10, wherein controlling the fabrication machinecomprises: providing a volume of non-hardened polymeric resin; andselectively hardening the resin in a shape corresponding to each of theappliances.
 12. A method as in claim 11, wherein hardening comprisesscanning a laser to selectively harden the resin.
 13. A method as inclaim 11, wherein scanning produces an appliance comprising a thinpolymeric shell.
 14. A method as in claim 9, wherein controlling thefabrication machine comprises: providing a volume of non-hardenedpolymeric resin; and selectively hardening the resin in a shapecorresponding to each of the polymeric shell appliances.
 15. A method asin claim 14, wherein selectively hardening comprises scanning a laser toselectively harden the resin.
 16. A method as in claim 14, whereinscanning produces an appliance comprising a thin polymeric shell.
 17. Amethod for fabricating a plurality of dental incremental positionadjustment appliances, said method comprising: providing digital datarepresenting a plurality of successive tooth arrangements progressingfrom an initial tooth arrangement to a final tooth arrangement; andcontrolling a fabrication machine based on the digital data to producethe appliances wherein controlling the fabrication machine comprises:providing a volume of non-hardened polymeric resin; and selectivelyhardening the resin in a shape corresponding to each of the polymericshell appliances.
 18. A method as in claim 17, wherein providing thedigital data comprises providing a plurality of digital data sets,wherein each set represents one of the successive tooth arrangements.19. A method as in claim 17, wherein the fabrication machine iscontrolled to produce polymeric shell appliances.
 20. A method as inclaim 17, wherein selectively hardening comprises scanning a laser toselectively harden the resin.
 21. A method as in claim 20, whereinscanning produces an appliance comprising a thin polymeric shell.